In the last decade mobile technology has become an increasing part of our lives with studies suggesting that people have their mobile phone with in arms reach nearly 60% of the time. With the growth in mobile technologies has come  an range of applications to track and monitor health outcomes (mHealth).

The aim of this review was to evaluate the effectiveness of mobile applications and text messages, compared with standardized oral hygiene instructions, in improving oral health knowledge and/or reducing gingival inflammation, when delivered to adolescents, adults and mothers of young children.

Methods

Searches were conducted in the Cochrane Library, Medline/PubMed, Scopus, Embase and Google Scholar databases with no restrictions on language or date of publication.  Randomised controlled trials (RCTs) involving mobile apps or text messages to improve oral hygiene in comparison with conventional methods were considered. Studies had to present either plaque index or gingival index as outcomes and/or a behavioural change measure as an outcome.

Two reviewers independently screened the studies, extracted data and assessed risk of bias using the Cochrane tool and the GRADE system. Data on mean difference and standard deviation were extracted or calculated from the studies and standardised mean difference (SMD) between baseline and last follow-up time was calculated. Random effect meta-analysis was conducted.

Results

• 15 studies involving a total of 1402 patients were included.
• A majority (11) involved text messaging of adolescents undergoing orthodontic treatment.
• 12 of the 15 included studies in total used text messaging.
• All of the included studies were at high risk of bias for the blinding of participants and personnel.
• Meta-analysis indicated a significant improvement in dental plaque control and gingival bleeding for groups that received the mobile health (mHealth) strategy.
  • Plaque index (10 studies)       SMD = -9.43 (95%CI; -14.36 to -4.495) I² = 99%.
  • Gingival bleeding (7 studies) SMD = -8.54 (95%CI; -13.16 to -3.91) I² = 99%.
• The overall quality of the evidence was rated as very low using the GRADE system.

Conclusions

The authors concluded: –

mHealth strategies can be used as an adjunct component in the improvement of daily self-performed oral hygiene. Further studies should be developed to evaluate mHealth strategies as adjunct interventions to supplement standard oral care for patients in different age groups.

Comments

The reviewers have undertaken a broad search strategy to identify relevant studies. The included studies show a high degree of variability and all have a high degree for bias, typically because of a lack of patient and study personnel blinding. A majority of the studies involved text messaging for adolescents typically orthodontic patients and while the findings suggest reductions in plaque and gingival bleeding their findings may not be generalisable to other groups. The reviewers have classified the interventions in the studies using a behavioural change taxonomy although it is not clear whether the approaches used in the original studies were designed with these behavioural approaches in mind from the outset.

Mobile or digital approaches to health are recent and new developments are appearing all the time, this review does suggest that early approaches using text-based reminder may have a positive effect in the short-term. However, new more sohpisticated applications are likely to be produced and these together with  higher quality better designed studies are needed. There also needs to be a greater focus on medium to longer term benefits.

Links

Primary Paper

Toniazzo MP, Nodari D, Muniz FWMG, Weidlich P. Effect of mHealth in improving oral hygiene: A systematic review with meta-analysis. J Clin Periodontol. 2019 Mar;46(3):297-309. doi: 10.1111/jcpe.13083. Review. PubMed PMID: 30761580.

Other references

Dental Elf -24^th Aug 2018

Orthodontic patients: Reminders improved oral hygiene and compliance